Published in Panorama
Screening babies for Hypothyroidism, a must
Hypothyroidism is a condition in which there is too little thyroid hormone in the bloodstream. The condition, for reasons unknown, affects women more than men and the incidence in women is particularly high around the age of 50, especially if they have lipid or cholesterol problems.
Hypothyroidism can affect all ages of people though it mostly affects individuals between the ages of 20 to 50 years. Normal levels of thyroid hormone are necessary for the proper growth and development of a child. Consequently, hypothyroidism in infants and young children can lead to serious and sometimes permanent developmental problems if not identified and treated on time, explains Dr.Belal Alshammaa, Endocrinologist and Diebetologist, American Hospital, Dubai.
Symptoms of hypothyroidism are very subtle and patients feel normal and complain of vague complaints. Very often, we discover the condition only incidentally when patients come for treatment of some other problems, says Dr.AlShammaa.
“Babies born with hypothyroidism may show a number of symptoms in the first weeks to months of life though these are very subtle and can therefore be missed. These include prolonged jaundice soon after birth, cool mottled skin, poor feeding and constipation, increased sleepiness, umbilical hernia, larger than normal tongue and larger-than-normal soft spots on the skull.
Symptoms of hypothyroidism in older children and adults are related to sluggish functioning of the body wherein the individuals feel tired, fatigued, lethargic, drowsy and sleepy all the time. They have a slow heart rate, dry flaky skin, puffy face especially around the eyes, manifest hair fall, impaired memory and concentration, constipation, irregular monthly cycles in girls and women, and above all, these patients are intolerant to cold – they feel cold all the time”, explains Dr.AlShammaa.
How common is hypothyroidism in newborns? Congenital Hypothyroidism is a condition that exists from birth and affects roughly 1 in 4000 newborns. These babies are either born without the thyroid gland or the gland is not functioning; the glands may not produce sufficient amounts of the hormone necessary for proper body functions, or, in rare occasions, the Thyroid Stimulating Hormone (TSH) in the pituitary gland which is responsible for the production of the hormones of the thyroid gland, is not produced or released for some reason.
However, in about 10% of newborns, this condition may be rather temporary and will resolve by itself in some days or months, depending upon the underlying cause. For instance, if the mother has Graves' disease, an autoimmune disorder which makes the thyroid gland produce too much thyroid hormone. A thyroid-blocking antibody may cross from the mother's bloodstream into the baby's blood. This may cause the baby's thyroid gland to temporarily stop producing thyroid hormone. More commonly, the anti-thyroid drug being taken by the mother for the treatment of her hyperthyroidism, affects the normal functioning of the baby's thyroid gland.
It is extremely important to identify the condition because there will be no symptoms until the infant develops and grows at least a few months, emphasizes Dr.AlShamma. But by the time the baby is 6 months to a year, it may be too late to deal with the problem of hypothyroidism since the damage caused by the problem may not be reversible! By about six months when symptoms may appear in the form of retarded growth, the brain function is already inhibited and these babies grow up into adulthood and have to live retarded all their lives. Therefore it is extremely important, to screen every newborn for hypothyroidism, shortly after birth.
Which definitely implies that regardless of the existence of risk factors, every newborn must be screened for hypothyroidism. “Yes, every baby, most definitely. Though the chance of a baby being born with hypothyroidism may be only 1 in 4000, the screening is worth the trouble since it costs very little and the test is very simple and the treatment is very easy should the test turn positive. If identified and timely treatment with hormone replacement is given at this stage in life, the baby will grow up to be like any other normal individual who does not have the problem”, emphasizes Dr.AlShammaa.
This means, intervention with hormone replacement can reverse the process, 100%. But should the treatment be delayed even until 6 months to a year, it may be too late to reverse any damage that would have already set in, reveals Dr.AlShammaa.
Is it possible that treatment for hypothyroidism with hormone replacement can result in hyperthyroidism? Yes, it is possible that an individual is over-treated by being given more hormone than is necessary. This would result in drug-induced hyperthyroidism. In such instance, the child may have problem with its growth as the bones will mature faster and will be prone to osteoporosis and other problems later in life.
However, it is possible to reverse these problems if the dosage of the hormone is reduced, assures Dr.AlShammaa. “But this depends on the over treatment exposure. It will depend upon how fast you catch on to the over dose of the treatment. If you keep a person over treated, say, for 10 years, this person will certainly have more risk of osteoporosis than when he/she is well treated.”
However, it is possible to monitor the right amount of hormone replacement that is required. Dr.AlShammaa explains, “Of course we have the blood test results which are very accurate and precise. Initially we do a blood test every 6 – 8 weeks to hit upon the right amount of the hormone to be replaced. Once this is done, we normally advise a blood test every six months for growing children and once a year for adults to ensure that right levels of the hormone are administered.”
It is believed that certain lithium based drugs used in psychiatric conditions and iodine-containing drugs used for heart disorders, may cause hypothyroidism by inhibiting the production of thyroid hormone. Is this true? Dr.AlShammaa responds, “Actually, the most common iodine-containing drug is amiodarone which is commonly used in dealing with cardiac arrhythmia. This drug is very rich in iodine. And large doses of iodine over a short period of time can inhibit the release of the thyroid hormone and that is why this will affect thyroid function.
However, this drug acts in a way whereby there are several phases of either Hypo- or Hyperthyroidism being present. Often it is not possible to predict which way the condition will go. Hence, these patients who are on this drug, will have to be monitored for their thyroid function throughout the course of treatment with amiodarone. Lithium too inhibits the release of thyroid hormone but it is not as worrisome as amiodarone which creates the greater problem.”
Hypothyroidism Diagnosis involves Blood tests, which check levels of thyroid hormones T4, T3, and TSH. TSH is a very important marker for thyroidism. When TSH is very low, the thyroid is working too much and vice versa. Besides, the thyroid antibodies and thyro-globulin measures may need to be checked. Imaging studies of the thyroid, including ultrasound and nuclear scan may be done when necessary, says Dr.AlShamma.
Almost all individuals with hypothyroidism will require thyroid hormone replacement therapy for the rest of their lives, reveals Dr.AlShammaa. Fortunately, thyroid hormone is simple to take, and the success of therapy is easily monitored by blood tests for T4 and TSH that can be done throughout adulthood.
Unfortunately, since the cause of Hypothyroidism is not really known, it is not possible to be prevent the condition says Dr.AlShammaa.